Healthcare Fraud Archives - Page 112 of 126

December 18, 2015

Maryland-based splint supplier Dynasplint Systems Inc., and its founder and president, George Hepburn, agreed to pay roughly $10.3 million to resolve allegations they violated the False Claims Act by improperly billing Medicare for splints provided to patients in skilled nursing facilities. According to the government, to circumvent Medicare rules which provide for bundled payment to these facilities that cover all of a patient’s needs, Hepburn and Dynasplint mispresented that patients were in their homes or other places that were not skilled nursing facilities. The allegations first arose in a whistleblower lawsuit filed by former Dynasplint sales executive Meredith Deane under the qui tam provisions of the False Claims Act. Ms. Deane will receive a whistleblower award of roughly $2 million from the proceeds of the government’s recovery. DOJ

Tagged in: Bundling and Unbundling, FCA Federal, Healthcare Fraud, Medical Devices and DME, Whistleblower Case, Whistleblower Rewards,

December 7, 2015

The former owner, operator and managers of Southern California ambulance company ProMed Medical Transportation were sentenced to prison for their role in a fraud scheme that resulted in more than $1.5 million in fraudulent claims to Medicare. Yaroslav Proshak (aka Steven Proshak) was sentenced to serve 108 months in prison. On December 2, Emilia Zverev and Sharetta Michelle Wallace were sentenced to serve 36 and 24 months, respectively. In addition, Zverev and Wallace were ordered to pay restitution jointly and severally with Proshak in the amount of $804,755. The evidence at trial showed that the defendants conspired to bill Medicare for ambulance transportation services for individuals that did not need such services. The defendants also instructed ProMed EMTs to conceal the patients’ true medical conditions by altering paperwork and creating fraudulent documents to justify the services. DOJ

Tagged in: Healthcare Fraud, Medical Billing Fraud,

December 1, 2015

Wisconsin-based Pharmasan Labs, Inc., its related billing company NeuroScience, Inc. and their founders, Gottfried and Mieke Kellermann, agreed to pay $8.5 million to resolve charges they violated the False Claims Act by (i) submitting false information for laboratory services, and (ii) violating Medicare rules for services referred by non-physician practitioners. According to the government, and as admitted by Pharmasan under the settlement, Pharmasan falsely billed Medicare for ineligible food sensitivity testing; knew Medicare prohibited payment for such testing; and submitted false information to Medicare to disguise the type of test it was performing so Medicare would cover it. Pharmasan also admitted violating Medicare billing rules which bar payment for lab services referred by non-physicians. The government investigation leading to the settlement originated from a whistleblower action filed under the qui tam provisions of the False Claims Act. The whistleblower will receive a whistleblower award of roughly $1.1 million from the government’s recovery. Whistleblower Insider

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Laboratory and IDTF, Medical Billing Fraud, Whistleblower Case, Whistleblower Rewards,

November 20, 2015

Huey P. Williams Jr., owner of Houston-area based durable medical equipment companies Hermann Medical Supplies Inc. and Hermann Medical Supplies II was sentenced to 63 months in prison and to pay $1.96 million in restitution for his role in a $3.4 million Medicare fraud scheme. Specifically, Williams caused Hermann Medical to bill Medicare for components of an “arthritis kit,” which included expensive, rigid braces and orthotics with adjustable joints that required fitting and adjustment, when in reality, Williams purchased and provided to beneficiaries only inexpensive, flimsy neoprene braces and equipment, to the extent he provided any equipment at all. DOJ

Tagged in: Healthcare Fraud, Medical Devices and DME, Medicare,

November 19, 2015

Detroit-area physician Dr. Hicham A. Elhorr was sentenced to 72 months in prison and to pay roughly $2 million in restitution for directing a multi-million dollar Medicare fraud scheme through his medical practice. According to admissions in his plea agreement, Elhorr employed unlicensed individuals through his visiting physician practice, House Calls Physicians PLLC, who held themselves out as licensed physicians and purported to provide physician home visits and other services to Medicare beneficiaries in Michigan. The unlicensed individuals prepared medical documentation that Elhorr and other licensed physicians signed as if they had performed the visits when, in fact, no licensed physicians had treated the beneficiaries. DOJ

Tagged in: Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Medicare,

November 6, 2015

Roger Rousseau, former medical director of defunct health provider Health Care Solutions Network Inc. (HCSN) was sentenced to 192 months in prison for his role in a scheme to fraudulently bill Medicare and Florida Medicaid more than $63 million. Also sentenced to prison for their role in the scheme were therapists Liliana Marks for 72 months and Doris Crabtree and Angela Salafia, each for 60 months. According to evidence presented at trial, HCSN purported to provide intensive mental health services to Medicare and Medicaid beneficiaries but these services were not medically necessary and were often never even provided. HCSN also paid kickbacks to assisted living facility owners and operators who in exchange referred beneficiaries to HCSN. In support of this scheme, Rousseau routinely signed what he knew to be fabricated and altered medical records. And Crabtree, Salafia and Marks fabricated HCSN medical records to support the fraudulent claims. In total, HCSN submitted roughly $63.7 million in false and fraudulent claims to Medicare. DOJ

Tagged in: Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud,

October 26, 2015

Valentina Kovalienko, the owner of two Brooklyn medical clinics, pleaded guilty to, and agreed to forfeit almost $30 million for, her role in a $55 million health care fraud and money laundering conspiracy. According to her admissions, from approximately February 2008 to February 2011, Kovalienko and others executed a scheme in which patients were paid cash kickbacks to subject themselves to medically unnecessary physical and occupational therapy, diagnostic tests and office visits that were not performed by licensed professionals, and for which the clinics billed Medicare and Medicaid. Kovalienko also admitted that to support the fraudulent claims she paid occupational and physical therapists to falsify patient charts and billing records. DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Improper Medical Personnel, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, Provider Fraud,

October 16, 2015

A federal jury in Los Angeles convicted Amalya Cherniavsky and her husband, Vladislav Tcherniavsky, for conspiracy to commit health care fraud in connection with a $1.5 million Medicare fraud scheme. The evidence at trial demonstrated that Cherniavsky owned JC Medical Supply, a purported durable medical equipment supply company, and that she co-operated the company with her husband, Tcherniavsky, and that they paid illegal kickbacks to patient recruiters in exchange for patient referrals. The evidence further showed that the defendants paid kickbacks to physicians for fraudulent prescriptions – primarily for expensive, medically unnecessary power wheelchairs – which the defendants then used to support fraudulent bills to Medicare. DOJ

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Lack of Medical Necessity, Medical Devices and DME, Medicare,

October 14, 2015

Santiago Borges, Erik Alonso and Cristina Alonso, all of Miami, pleaded guilty to federal healthcare fraud charges. Borges owned the now-defunct mental health centers R&S Community Mental Health Inc. and St. Theresa Community Mental Health Center Inc., and was an investor in New Day Community Mental Health Center LLC . Erik Alonso was the clinical director of all three centers. Cristina Alonso was a therapist at R&S. They admitted the clinics billed Medicare for costly partial hospitalization program services that were not medically necessary or not provided to patients. Borges also admitted he paid kickbacks to patient recruiters who, in exchange, referred beneficiaries to the centers. DOJ

Tagged in: Healthcare Fraud, Hospital Fraud, Lack of Medical Necessity, Provider Fraud, Upcoding,

October 8, 2015

Evelio Fernandez Penaranda, owner of Miami-based Naranja Pharmacy Inc., was sentenced to 46 months in prison and to pay $1,876,241 in restitution for his role in the submission of more than $1.8 million in fraudulent claims to Medicare. According to his guilty plea, Naranja Pharmacy submitted fraudulent claims to Medicare for prescription drugs not prescribed by physicians, not medically necessary and not provided to Medicare beneficiaries. DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Medical Billing Fraud, Pharma Fraud,

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